Barriers and facilitators of trauma registries in low- and middle-income countries: A scoping review

Trauma registries are a critical component of mature trauma systems that have enabled robust outcomes measurement and quality improvement initiatives. In low- and middle-income countries (LMICs) where trauma mortality is disproportionately high, however, trauma registries have faced challenges in implementation and sustainability. This scoping review characterized recent LMIC trauma registry implementation efforts, synthesizing facilitators and barriers to inform best practices for future establishment and maintenance of trauma registries in resource-limited settings. We used the preferred reporting items for systematic reviews and meta-analyses - scoping review framework to conduct a scoping review of PubMed, Embase, and MEDLINE for articles published after 2017 that reported on trauma registry implementation efforts in LMICs. Data were extracted including duration of registry implementation, number of institutions, country, barriers and facilitators cited, and funding sources. Barriers and facilitators were thematically classified according to health systems building blocks and synthesized to create best practices recommendations based on pooled experience. Of 873 articles searched, 29 met the inclusion criteria. Information management was the most common barrier (22 articles, 76%) and the most common facilitator (18 articles, 62%). Other barriers and facilitators included workforce, infrastructure, financing, and organizational support. Fifteen studies (52%) reported multiple barriers to implementation, and 14 (48%) reported multiple facilitators. Average length of registry implementation was 20.2 months. Trauma registries in LMICs often face multiple barriers to implementation, most commonly in information management. However, previous implementers have overcome these barriers through best practices including standardized data collection, technological safeguards, engaging local stakeholders, dedicated data coordinators, and sustainable funding across multisite implementation projects.